The Center for Clinical Epidemiology and Biostatistics (CCEB) of the University of Pennsylvania (Penn) School of Medicine, in collaboration with the Universidad de San Carlos of Guatemala City (USAC), Guatemala, and Universidad de Francisco Marroquin (UFM), also of Guatemala City, Guatemala resubmits this application to develop an innovative clinical epidemiologic research training program in chronic diseases for clinicians and researchers from USAC and UFM. There will be two training pathways. The first. Independent Investigator training, is specifically designed to prepare physicians who are or will be junior faculty at USAC and UFM to become rigorous, independent academic investigators able to use the range of approaches available in clinical epidemiology to address important research issues regarding the etiology, prognosis, prevention and early detection, treatment, clinical economics, technology assessment, medical decision making, and quality of patient care of one or more chronic diseases. The second pathway, Associate Investigator training, is designed is to prepare clinicians and research staff at USAC and UFM to serve as collaborators in chronic diseases clinical epidemiologic research and/or policy formulation. Upon completion of training, graduates from both pathways will form chronic diseases clinical epidemiology research teams and join multidisciplinary research organizations in their home institutions, formed to synergize and support their research efforts. Year one of the two-year Independent Investigator training program will be conducted at Penn. Trainees will matriculate in the Master of Science in Clinical Epidemiology degree program and take courses in clinical epidemiology, research methods, biostatistics, and chronic diseases epidemiology; take elective courses; attend journal clubs and clinical research conferences focusing on research issues in one or more chronic diseases; read independently on appropriate topics; attend and participate in research seminars at the CCEB and clinical divisions; and design an independent research project. The second year, to be completed at their home institution, will be devoted to the conduct and completion of the independent research project. Trainees' mentors from Penn will visit during this year. Additional funds have been committed by the Guatemalan national government to provide supplemental salary support for the three years following completion of training to protect graduates' time while they then develop extramurally-funded research programs, on the condition that they do not develop private practices. The Associate Investigator pathway w\\\ consist of a series of short courses, workshops, and programs directed by Penn faculty, taught onsite and in Spanish at USAC and UFM and supplemented electronically via live two-way video conferences and web-based programs. Course topics will include research design/methods, biostatistics, data management, critical appraisal of the literature, regulatory affairs, patient privacy issues, and bioethics. Strengths of the program are the: (1) collaborative partnerships that Penn has already developed in Guatemala with USAC and UFM as part of its global health program; (2) CCEB's history of successful research training programs; (3) CCEB's experience as a founder of the International Clinical Epidemiology Network; (4) comprehensive course offerings that are available to chronic diseases clinical epidemiology trainees at Penn (Independent Investigator pathway); (5) training that will provide collaborators and staff for research teams {Associate Investigator pathway); (6) research organizations to which the trainees will be proposed to join; (7) substantial matching funds provided by Penn to maximize resources for the trainees; and (8) matching funds provided by the Guatemalan national government, protecting graduates' time for research and demonstrating a strong national commitment to their research careers. PUBLIC HEALTH RELEVANCE: There are major shortages of clinician scientists able to conduct rigorous and collaborative clinical epidemiologic research in chronic diseases in Guatemala. Critical diseases/health issues that can be addressed by these individuals include cancer, cerebrovascular disease including stroke, lung disease including chronic obstructive pulmonary disease, obesity as well as genetics, environmental factors including indoor air pollution, and lifestyle factors related to these conditions.